Week 5: ENT 2 (common conditions of the nose, mouth and throat) Flashcards
1
Q
Nasal polyps Background
A
- Fleshy, benign swelling of the nasal mucosa
- Usually bilateral: common (>40 years)
2
Q
causes of nasal polyps
A
- They result from chronic inflammation and are associated with:
- Asthma
- recurring infection,
- allergies
- drug sensitivity
3
Q
presentation of nasal polyps
A
- Polyps look slightly lighter
- In this pic: Emerge out of the middle meatus (between middle and inferior turbinate’s)
- Pale or yellow in appearance/ fleshy and reddened
- Symptoms
- Blocked nose and water rhinorrhoea
- Post-nasal drip
- Drip goes into the pharynx and larynx- irritation and cough
- Decrease smell and reduced taste
- Sinusitis- blockage of the sinus air cavities
4
Q
Unilateral poly +/- blood tinged secretion may
A
suggest tumour – cancer
5
Q
management of nasal polyps
A
Medical management with topical (nasal drops) and possibly systemic corticosteroids is usually considered the initial treatment of choice, with endoscopic sinus surgery reserved for those patients who fail to improve
6
Q
rhinitis
A
- Inflammation of the nasal mucosa lining
- Entire nasal cavity affected- bilateral
7
Q
causes of rhinitis
A
- Simple acute infective rhinitis (viral- common cold)
- Allergic rhinitis- similar symptoms to infective rhinitis
8
Q
presentation of rhinitis
A
- Nasal congestion
- Rhinorrhoea – runny nose
- Sneezing
- Nasal irritation
- Postnasal drip
9
Q
management of rhinitis
A
- Topical/ oral nasal antihistamines
- Topical intranasal steroids
- Nasal saline wash
10
Q
septal haematoma
A
- Potential complication from nasal injury
11
Q
septal haematoma causes
A
- Buckling(bending) of cartilage due to trauma
- Tears/shears blood vessel
- Accumulation of blood
- Strips perichondrium away from cartilage (nasal septum)
- Starving cartilage of blood supply
- Cartilage dies fibrosis and affects shape
- Infection can be an issue
12
Q
diagnosis of septal haematoma
A
must look up the nostrils for swelling
13
Q
management of septal haematoma
A
must be incised and drain and a tamponade placed to stick perichondrium back onto cartilage
But if you don’t treat septal haematoma- Saddle nose deformity
14
Q
acute sinusitis
A
<3 weeks
15
Q
background to acute sinusitis
A
- Inflammation of the mucous membrane of the paranasal sinuses
- Paranasal sinuses are air filled spaces lined with resp mucosa and therefor have cilia and goblets cells – extensions of the nasal cavity
Sinuses drain into nasal cavities via ostia’s into a meatus most commonly the middle meatus
16
Q
pathophysiology of acute sinusitis
A
- Infection leads to reduced ciliary function, oedema of nasal mucosa and sinus ostia and increased nasal secretions → that cant drain
- Maxillary most commonly affected due to gravity
- Stagnant secretions- breeding ground for bacterial infection
17
Q
causes of acute sinusitis
A
-
Causes
- Usually viral infection
- Rhinovirus
- Parainfluenza virus
- Only 3% require antibiotics
- Streptococcus pneumonia
- Haemophilus influenzae
- Usually viral infection
18
Q
presentation of acute sinusitis
A
- Facial pain- esp when looking down
- Headache
- Nasal discharge
- Loss of smell
- Nasal obstruction
- Coryzal symptoms- yellow sputum
- Vertigo if mucus builds up in eustachian tube
- Ear pain, tiredsness
19
Q
management of acute sinusitis
A
- Analgesia
- Intranasal decongestants and nasal saline
- Don’t give abx if symptoms have been present for 10 days or less
- Intranasal corticosteroids for 14 days if symptoms present for more than 10 days
- Oral abx e.g. phenoxymethylpenicillin if severe presentation
20
Q
chronic sinusitis
A
>3 months
21
Q
causes of chronic sinusitis
A
- Allergies esp hay fever and environment allergies
- Nasal polyps/ Deviated septum
- Resp tract infection
22
Q
management of chronic sinusitis
A
- Avoid triggers, stop smoking
- Nasal irrigation with saline solution to relieve congestion and nasal discharge
- Intranasal corticosteroids for up to 3 months
- Specialist referral if unilateral symptoms
- Recurrent otitis media/pneumonia in child
23
Q
deviated nasal septum
A
- A deviated septum occurs when the thin wall (nasal septum) between your nasal passages is displaced to one side. In many people, the nasal septum is off-center — or deviated — making one nasal passage smaller
24
Q
causes of deviated nasal septum
A
- Present at birth
- Injury to the nose
25
presentation of deviated nasal septum
difficulty breathing, crusting + bleeding, recurrent sinus infections, may also have no symptoms
26
investigations for deviated nasal septum
CT scan and nasal endoscopy
27
management of deviated nasal septum
* Nasal sprays including decongestants, antihistamine and corticosteroids
* **Surgery:** may need a septoplasty operation to correct the septum deviation if causing significant problems
28
nasal fracture causes
* Trauma to the nose
29
presentation of nasal fracture
deformity to the nose, swelling, skin laceration, ecchymosis, epistaxis and CSF rhinorrhea
30
investigations for nasal fracture
X-ray would only be needed with more serious injuries needing facial and skull x-ray
31
management of nasal fracture
* non-displaced fractures can be managed conservatively
* if displaced- manipulation under either local or general anaesthetic, , if not it may need surgery 12 months after the operation
* must also exclude complications like septal haematoma which would need draining
* Refer to ENT if required
32
salivary stones (sialothiaiss)
* Most stones are located in submandibular glands
* Dehydration, reduced salivary flow
* Most stoned less than 1cm
33
presentation of sialothiasis
* Pain in gland
* Swelling
* Infection
34
diagnosis of sialothiasis
* History
* X-ray
* Sialogram- contrast dye injected into gland
35
**Peritonsillar abscess ‘quinsy’**
*
* Diff to tonsilitis
* Affects tissue around the tonsil
* If its unilateral (quinsy)→ will deviate the uvula towards the swelling
36
**Pharyngeal tonsil (adenoid)- clinical correlates**
* Enlarged pharyngeal tonsils
* Block eustachian tube (recurrent/persistent middle ear infection
* Snoring/sleep apnoea
* Sleeping with mouth open
* Chronic sinusitis
* Sore throat
* Nasal tone to voice
37
dysphagia signs and symptoms
* Coughing and chocking
* Sialorrhea (drooling)
* Recurrent pneumonia
* Change in voice/speech (wet voice)
* Nasal regurgitation
38
causes of dysphagia
* **Stroke**
* 30% of post stroke death are due to pneumonia
* E.g. aspiration pneumonia
* Progressive neurological disease
* Parkinson’s/MS
* COPD
* Dementia
* MALIGNANCY e.g. oesophageal cancer
39
interventions of dysphagia
* Fluids are thickened
40
false diverticulum
Caused by a posteromedial (false diverticulum)→ arises in weakness between the 2 parts of the inferior constrictor (Killians dehiscence)
* Probably due to
* Failure of UOS to relax
* Abnormal timing of swallowing
* Essentially there is a higher pressure in laryngopharynx
* Weakness in inferior constrictor muscle produces outpouching
41
presentation of false diverticulum
bad breath
regurg of food
occasional choking on fluids
general difficulty swallowing
42
**Tonsilitis**
**inflammation of the palatine tonsils**
43
presentation of tonsillitis
* Fever
* Sore throat
* Pain/difficulty swallowing
* Cervical lymph nodes
* Bad breath
* Viral causes (most common)
* Bacterial causes (up to 40% of cases)
* Strep pyogenes
* White spots
* Can be bacterial secondary to viral tonsilitis
44
**injury to either the IX (glossopharyngeal) and X (vagus) can cause**
* Obvious things
* Absent gag
* Uvula deviated away from lesion (Lower Motor Neurone lesion)
* More subtle
* Dysphagia
* Taste impairment (posterior tongue IX)
* Loss of sensation oropharynx
45
**Injury to IX/V caused by**
Medullary infarct, jugular foramen issues (fracture)
46
injury to XII- hypoglossal
* Wasted tongue
* Stick tongue out- tongue may deviated
* Damage to nerve itself (LMN)- points to side of the lesion (tongue never lies)
* Muscle wasting
* Fasciculations
47
thyroid nodules differentials
* Common head and neck presentation with patient presenting with thyroid masses or nodules
* Can be benign or malignant
48
benign causes of thyroid nodules
* Colloid nodules
* Hyperplastic nodules
* Thyroid adenoma
* Thyroid cyst
* Viral thyroiditis
* Graves disease
49
malignant causes of thyroid nodules
50
investigations for thyroid nodules
* **Swallow and stick out tongue**
* Any lump related to thyroid will move on swallowing
* If the lump moves when tongue being stuck out- thyroglossal
* TSH and T4 levels
* US
* Fine needle aspiration if malignancy suspected
* Calcitonin levels, calcium and PTH in suspected PT pathology
* Radioactive iodine uptake- graves and multinodular goitre and thyroiditis differentiation
51
presentation of thyroid nodule
* **Presentation**
* Mass effect symptoms of thyroid neck lump
* SOB due to tracheal compression
* Dysphagia
* Hoarseness- irritation of recurrent laryngeal nerve
* Hyperthyroid symptoms
* Systemic malignant features e.g. weight loss, night sweats and lymphadenopathy
* Hypothyroid symptoms
52
cervical lymphadenopathy
* Enlargement of cervical lymph nodes in the neck region
* Important clinical indicator of underlying condition of infection
53
causes of cervical lymphadenopathy
* Throat infection
* Dental decay
* Ear infection
* Salivary glands
* Cancer
* HIV, HEP
54
presentation of cervical lymphadenopathy
* Cervical lymph nodes are usually very small cand cannot be felt upon touch until underlying infection or malignancy has triggered increase in size
* Symptoms
* \>6 weeks
* Firm, hard
* Lymph nodes \>2cm
* Unintentional weight loss, night sweats, appetite loss
* Exposure to HIV or hep
* Unexplained fever
* Any associated facial swelling
55
diagnosis of cervical lymphadenopathy
* Physical exam
* US, CT and MRI
* Further test dependent on findings of examination
* Biopsy needed if malignancy is being considered
* Persistent cervical lymphadenopathy- FBC, LFT, CRP
